If a defibrillator is not readily available, brain death will occur in less than 10 minutes.

One way of buying time until a defibrillator (AED) becomes available is to provide artificial breathing and circulation by performing cardiopulmonary resuscitation, or CPR.

The earlier you give CPR to a person in cardiopulmonary arrest (no breathing, no heartbeat), the greater the chance of a successful resuscitation.

By performing CPR, the affected individual receives oxygenated blood flowing to the heart and brain until a defibrillator becomes available.

CPR is one link in what the American Heart Association calls the "chain of survival." The chain of survival is a series of actions that, when performed in sequence, will give a person having a heart attack the greatest chance of survival.

The first link in the chain of survival is immediate recognition of cardiac arrest and activation of the emergency response system by calling 911 (check your community plan, some communities require dialing a different number).

The next link in the chain of survival is to perform CPR until a defibrillator becomes available.

The next link in the chain of survival is to perform early CPR, with an emphasis on chest compressions until a defibrillator becomes available.

Following early CPR, the next link is to provide rapid defibrillation.

may be available for use by the lay public or first person on the scene.

Once the EMS unit arrives, the next link in the chain of survival is effective advanced life support care. This involves administering medications, using special breathing devices, and providing additional defibrillation shocks if needed.

NOTE: This reference is only intended to serve as a guideline for learning about CPR. It is not intended to be a replacement for a formal CPR course. If you are interested in taking a CPR course contact the American Heart Association at (800) AHA-USA1, or the American Red Cross by phoning your local chapter. Never practice CPR on another person, because bodily damage can occur.

Cardiac Arrest

When a person develops cardiac arrest, the heart stops beating. There is no blood flow and no pulse. With no blood flowing to the brain, the person becomes unresponsive and stops breathing normally.

When you discover a person whom you believe is experiencing a medical emergency, the first thing to do is check for responsiveness. Gently shake the victim and shout, "Are you OK?"

If the person does not respond to your voice or touch, they are unresponsive. If the victim is unresponsive and you are alone, leave the victim and immediately call 911. If someone is with you, tell him or her to call 911 and then return to help you.

If an AED is available, bring it back to the person's side. The moment an AED becomes available, IMMEDIATELY press the "on" button. The AED will begin to speak to you. Follow the directions to use the AED.

Continuing Evaluation

You now need to check to see if the person is not breathing or not breathing normally (such as "gasping").

Start with Chest Compressions

If the person is not breathing normally, begin doing chest compressions. Place the heel of one hand on the center of the chest, right between the nipples. Place the heel of your other hand on top of the first hand. Lock your elbows and position your shoulders directly above your hands. Press down on the chest with enough force to move the breastbone down about 2 inches. Compress the chest 30 times, at a rate of at least 100 times per minute (slightly faster than once every second). Allow the chest to completely recoil after each compression.

The 2015 CPR recommendations for bystanders states that untrained bystanders should perform compression-only CPR (Hands-Only CPR). Bystanders trained in CPR who can perform breaths should do so in a cycle of 30 compressions and two breaths as decribed above.

The chest compression rate and depth were updated in 2015. In adult victims of cardiac arrest, it is reasonable for rescuers to perform chest compressions at a rate of 100 to 120 compressions per minute to a depth of at least 2 inches for an average adult, while avoiding excessive chest compression depths of greater than 2.4 inches.

CPR in Children

Sudden cardiac arrest is less common in children than it is in adults. It usually occurs when there is a lack of oxygen caused by a breathing problem such as choking, near-drowning, or respiratory infections.

In order to use an AED on a child from one year of age through eight years of age a special pediatric cable is used to reduce the amount of energy provided by the electrical shock.

Doing CPR on children aged one year to eight years is similar to doing CPR on adults. However, there are some minor differences. Most are due to the child's smaller size.

When compressing the chest, the heel of only 1 hand is used instead of two hands, and the chest is pressed down approximately 2 inches.

Compressions should be done at a rate of 100 to 120 compressions per minute at a depth of about 1.5 inches for infants, about 2 inches for children and at least 2 inches but no greater than 2.4 inches for adolescents.

If rescuers are unwilling or unable to deliver breaths, they should perform compression-only CPR (Hands-Only CPR).

CPR in Infants

An infant is defined as a child younger than one year of age. Because an infant is smaller than a child, the CPR technique for infants contains further changes.

Even smaller breaths are given-enough to just get the chest to rise. Only two fingers are used to compress the chest down about 1 and 1/2 inches.

Otherwise, the CPR sequence is the same as for the child.

Manual defibrillation is the preferred method of defibrillation in infants, however, if only an AED is available, it is recommended that a pediatric AED cable be used for infant defibrillation.

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CPR Pictures

Check for responsiveness by gently shaking the victim and shouting, "Are you OK?". Click to view larger image.

If the victim is unresponsive, immediately call 911. If an automated external defibrillator is available, bring it to the person's side.
Click to view larger image.

The moment an AED becomes available, IMMEDIATELY press the "On" button. The AED will speak to you. Follow the directions given.
Click to view larger image.

Place the heel of one hand on the center of the chest, right between the nipples. Place the heel of your other hand on top of the first hand. Lock your elbows and position your shoulders directly above your hands. Press down on the chest with enough force to move the breastbone down about 2 inches. Compress the chest 30 times, at a rate of at least 100 times per minute.
Click to view larger image.

Provide two rescue breaths. Place you mouth around the victim's mouth; pinch off the nose and administer two slow breaths. Make sure the chest rises with each breath. Click to view larger image.

Repeat the 30 compressions and two breaths until help arrives. Click to view larger image.

Hands-Only CPR - No More Mouth-to-Mouth?

The American Heart Association (AHA) has taken steps to simplify
the process of helping victims of cardiac arrest by introducing "hands-only"
CPR. Since only about 1/3 of people who suffer a cardiac arrest at home or at a
public place actually receive help, bystanders could be afraid to initiate CPR
for fear that they'll do something wrong or won't know what to do. Others may be
reluctant to perform mouth-to-mouth breathing for fear of contracting an
infection.

In short, the procedure for "hands-only" CPR is simple. An untrained
bystander who sees an adult suddenly collapse (after verifying that the person
is unresponsive and is not breathing) should do just two things:...